Denied for PTSD even though diagnosed and treated by the VA

[Christypl]

My husband applied for compensation for PTSD among a few other things.   He was seeing a private dr at the time.  He had a bad C&P exam (examiner asked only a couple of questions and the exam was about 5 minutes) and the first go was denied.  They said that he didn't have PTSD and he ended up with 10% for hearing loss.  We appealed the decision.  In the meantime, he started being seen regularly at the VA and was given a diagnosis of chronic PTSD.  We submitted supporting evidence about the stressor (mission logs, an article from the Marine Times and a buddy letter.  Today, he got his decision and it said that the PTSD was not service connected. What are we missing? Do we need a dr to flat out say that his PTSD was caused by combat?

[vetquest]

That is what your C&P was supposed to be for.  A private doctor cannot diagnosis your husband with PTSD, only a VA doctor can.  I would appeal again and ask for a new C&P exam to take into account his recent treatment at the VA.  If they grant the new C&P it should go better.  If it does not document how long the exam takes and how the doctor behaved.  If you appeal and cannot get a new C&P then I would appeal to the BVA.  These appeals can take a while in the VA Hamster wheel though and I would not go there first.

You are not missing anything, this is just how the VA operates sometimes.

Edited August 9, 2019 by vetquest

[Christypl]

Thank you so much for taking the time to answer.  We will definitely take your advice.

[broncovet]

I agree.  You are gonna need:

1.  A current diagnosis of ptSD by a VA doc.

2 . Documentation of an in service event, called a stressor.  

3.  A nexus, or docs opinion that your PTSD is at least as likely as not due to (your in service stressor).  

     If you dont have all of these DOCUMENTED, you will get denied every time.  Get your cfile and see if all 3 caluza elements are documented.  

[Berta]

Can you scan and attach the denial here to include the evidence list?

Cover the C file # and name prior to scanning it.

You might not be missing anything- maybe the VA missed something.

"and was given a diagnosis of chronic PTSD"-was this a VA psychologist?

Perhaps  he/she would be able to do a DBQ.

With the evidence you mentioned it is hard to believe VA did not grant the PTSD claim, but as a hardcore claimant myself, that has happened to me multiple times....and to many others here. They have the evidence they need, but VA does not consider it.

Was the buddy in the same unit, same time and place, and did he give a detailed eye witness account, that put him and your husband at the scene?

Did the buddy give his contact info to the VA?

 

 

 

 

[Buck52]

Yes we need what they decided  reasons and bases (What We Decided) why he was denied.  to help you further.

I take it because he was not diagnosed? but you resubmitted and included the dx? correct?

As Vetquest and Bronco mention he needs the things they mention.

Edited August 10, 2019 by Buck52

[SameOldSong]

OK, despite treating you for Complex PTSD, you may not end up with a PTSD rating.  Here's why:

(Read along with me on the DBQ form, please: 

https://www.vba.va.gov/pubs/forms/VBA-21-0960P-3-ARE.pdf      )

Skip down to Section V, Clinical Findings.  The stuff above Section V is using the findings to rate you in the sections above.

Section V involves your past history.  Trust me, any of us with PTSD has a 90% chance of having a very unhappy childhood with a lot of attachment issues and possible abuse.

Now, they'll try to blame all of your problems on your unhappy past. Or drug use.  If you admit sniffing the white lady (cocaine) or doing other drugs or heavy alcohol usage, they'll try to pin the problems on that. Then it's your fault and they don't have to rate you.

Sentinel events are things that are vivid in your past that stand out.  A traumatic event that happened before the military service. They'll say your problems were prior to service, but if the military stressors made your problems worse, they are still liable.

Section VI is the important point and they need something in Criterion A through F.  All of them. Not just a couple of things, every Criterion MUST be there, or it's not PTSD.  Every Criterion. 

There must be a specific stressor event. Lots of fear with combat zones and possible IEDs and watching your buddies get hurt daily around you WILL NOT CUT IT.  There must be a specific event.  A particular attack or bombing.  All of the attacks that end up in the military reports are put together and sent to an archive that tracks these events. Your stressor will be checked at this center and must match within a timeframe of a couple of months.  (The name of the center is  the Joint Services Records Research Center.)

The utter crap of PTSD is that our memory of these events is shattered into fragments. We can't remember timeframes or events or faces or sequences of events clearly. For the Vietnam guys, we suggest that they try to remember whether it was Monsoon or Dry Season.  For Iraqi, try to remember if there was some event that was near your stressor like Ashura or Eid Al-Adha or Ramadan. Or if the dates were ripening. Something that could be in a season or timeframe within two months of the event.

Back to the Criterion. Let's start with A:

Criterion A: The Veteran experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. AND  The Veteran's response involved intense fear, helplessness or horror

So, BOTH of these conditions have to be there.  You saw threats to others or saw something awful and as a result of it, felt intense fear, helplessness or horror.  Once again, it had to be a particular event. And it had to fit the criteria above.

Criterion B: There are several conditions under Criterion B. At least one of them must be experienced, or they check the last box that states that the traumatic event is not re-experienced. And we do re-experience that crap in PTSD. It ambushes us at odd moments due to some thing we see or do or hear and leaves us lost in the event memories. In my own PTSD experience, I can tell you that I hit every one of those conditions in Criterion B. I trigger on some random minor thing and suddenly I can see stuff in pieces from the event.  It's awful. One of my jobs before I got checked into Happy Meadows to sort it out refused to let me call the fire department to report something burning in the office because I'd smell burning metal all the time. I also was seeing and hearing hallucinations of the event pieces disconnected. And I'd wake up either choking and unable to breathe or I'd have night terrors. That's always fun for your spouse/partner.  I'm putting the criterion here in case the VA disappears the PTSD DBQ the way the TBI DBQ vanished:

• Recurrent and distressing recollections of the event, including images, thoughts or perceptions.
• Recurrent distressing dreams of the event.
• Acting or feeling as if the traumatic event were recurring; this includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when intoxicated.
• Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
• Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Criterion C : Criterion C is avoidance and numbing.  You avoid anything to keep from remembering. You can't remember it clearly. You turn off your feelings so that you can't feel because otherwise this crap will sink you. In Criterion C, not all of them have to be met. But at least 3 of them do have to happen. The Criterion:

• Efforts to avoid thoughts, feelings or conversations associated with the trauma.
• Efforts to avoid activities, places or people that arouse recollections of the trauma.
• Inability to recall an important aspect of the trauma.
• Markedly diminished interest or participation in significant activities.
• Feeling of detachment or estrangement from others.
• Restricted range of affection (e.g., unable to have loving feelings).
• Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children or a normal life span).

Criterion D : Persistent symptoms of arousal, at least 2, not present before the trauma. They have to have started since the stressor occurred.

• Difficulty falling or staying asleep.
• Irritability or outbursts of anger.
• Difficulty concentrating.
• Hypervigilence
• Exaggerated startle response

Criterion E : Duration of symptoms. This has to show that this is ongoing and persistent. It has to have happened for greater than a month.

Criterion F : The PTSD symptoms are ripping your life up in social, occupational, or other important areas of functioning.  I can't seem to hold a job because job stress has a tendency to make my PTSD symptoms surface and romp around the office. It freezes me. I can't think or function and end up in panic attacks often.

If the evaluator asked those 5 or 6 questions for the Criterion above and you didn't have the response that fits the VA definition of PTSD, then they will rate you as not having PTSD. 

Event -> Symptoms -> Your Reactions -> Long Duration -> Destruction of Your Life.

That's what they look for.  Then, once they establish PTSD, they look for how it's impacting you.  That's Section VII - Symptoms. This is where they decide the level of impact on your life. Of course you won't have all of these. It's impossible to have every single one because some are diametrically opposed.

Section VIII - Other Symptoms.   If you have something going on that wasn't on that Section VII list, then it should be listed here.

Section IX: Are you competent to handle your financial affairs?   My pdoc basically said to me that it was best if my spouse took over all financial matters. I have immense problems with this, but he was right.

Section X : Remarks.  If there's anything else missed, your pdoc should put it here. Mine mentioned that my symptoms through a particular set of circumstances caused me to gain weight.

So, that's how you can be treated for Complex PTSD by the organization that won't verify your PTSD. It's the Criterion A-F. If you don't hit every one, you don't have PTSD by their standard. Because the VA's standard of PTSD hinges on one event causing the PTSD. Not a weardown over months that makes you manifest the PTSD symptoms. "Complex PTSD" means that it was gained through numerous events that created an environment of fear, not simply one.

Appeals on PTSD take years. And he didn't nail down the criterion. If he works with his treatment team and manages to remember a particular event **and timeframe of that event** that left him in horror, file a new case because you have new evidence. Always, always tell them the truth. They'll figure it out, if you aren't telling them the truth. But I suspect the first question the evaluator asked was, "what event occurred to create your PTSD?" or some variation of that.  And then I suspect he answered, "well, it was not a particular event but there was all this stuff always happening." 

And that would be that. Not PTSD. No criterion met. No need to go further.